Florida state representative Pete Nehr has penned an op/ed that is very timely.

Part of it:

As an elected state representative, one of my most important duties is to provide for the safety of my constituents. As you read this, the largest nursing home chain in the United States, HCR Manor Care, is being purchased by the Carlyle Group, a private equity firm that owns Dunkin’ Donuts, Baskin Robbins and Hertz Rental Cars. The details of this acquisition are particularly worrisome. Carlyle will pay for the company by loading it down with $5.5-billion in debt. To pay back this debt, Manor Care will have strong incentives to do what 60 percent of other nursing homes purchased by private investment firms have done: cut costs by significantly reducing staffing, sometimes below federally recommended levels, and cutting other budget items at the expense of patient care.

At the same time, Manor Care’s executives will be making up to $250-million in this deal and the Carlyle Group stands to make up to $60-million.

He’s written much more so make sure you check it.

In South Dakota state legislators are considering using the state pay model for it’s nursing homes and training centers.

PIERRE - Turnover caused by low pay is creating what one lawmaker called a “looming crisis” in staffing South Dakota’s nursing homes and adjustment training centers.

The Legislature’s Appropriations Committee recently discussed - without taking action - a possible pilot program to use a state-employee style of pay for direct-care workers in nursing homes and training centers, which work with people with disabilities.

Such a plan could cost millions of dollars from the state treasury. Without action, a center or nursing home might close, throwing the burden of care for its residents or clients onto the state, some lawmakers fear.

Sen. Jerry Apa, R-Lead, said some reports show turnover rates of 48.5 percent for some direct-support staff.

“The fact of the matter is, we have a looming crisis here, and if we don’t get a hold of it and address it, one of the ATCs is going to close,” Apa said, according to audio minutes of the meeting.

Rep. Jim Putnam, R-Armour, who helps lead the Joint Appropriations Committee with Apa, also anticipates a growing problem unless change is made.

“I don’t think anyone in the state wants to have a nursing home or an ATC or any of the other folks that care for people close up,” Putnam said. “I don’t know that’s a problem at the moment, but it certainly could be one on the horizon.”

Read the rest of this article; some interesting stuff!

A CNA/artist uses her talent to brighten up holidays.

Obert, a certified nurses assistant, uses her spare time as an artist to make her workplace, San Juan Living Center, a little more colorful. A self-proclaimed Halloween “nut,” she typically decorates for the Christmas season but decided to expand to other holidays this year.

“I have been a CNA going on 12 years now,” Obert said. “But I really like to add a little to my residents’ hallway if I have the time. I enjoy making decorations and hanging them up. I am in a cardboard phase right now.”

Obert drew various cardboard characters that her husband cut out and she then painted. She collects cardboard from leftover boxes from her work, and for larger pieces, her husband gathers refrigerator boxes.

“Halloween is my favorite holiday, but normally I would just decorate for Christmas,” she said. “The residents really enjoy it. I am always looking at Halloween decorations, but with the prices really going up, I started looking at stuff more closely. I thought to myself, ‘hey this stuff is kind of flimsy and I could make things better than I could buy.’”

I bet she would make a great Activities Assistant!

From Michigan:

The federal My Choice program allows someone who needs a nursing-home level of care to remain at home and receive needed care, Justice said. Medicaid covers the costs if the consumer meets the income and asset guidelines, said Jim McGuire, director of planning and advocacy for AAA 1-B.

“To be eligible for My Choice, a consumer must be 65 or older and medically eligible for a nursing home or 18 and older with a disability and also medically eligible for a nursing home,” Justice said.

A consumer also can be a nursing home resident and be “assessed to return home” to receive My Choice assistance.

However, an individual’s monthly income cannot exceed $1,869 to receive My Choice assistance. Assets also are limited to $2,000, excluding a home.

Under My Choice, a consumer can receive personal care, homemaking, respite for caregivers, adult-day service, home-delivered meals, private duty nursing, personal emergency response systems, chore services such as cleaning out gutters or snow removal, counseling, home injury control, such as putting in bathroom grab bars, medical equipment supplies and training of caregivers, Justice said.

Those eligible for My Choice, “may need to supplement the costs of the services” based on ability to pay, she said.

After the eligibility evaluation process, a care plan is formulated and discussed with the consumer and his or her family.

Two Congressional Committees have agreed to investigate the dealings of Carlyle Group and other private investment firms, and the management practices of nursing homes.

Two Congressional committees announced yesterday that they would investigate business practices at nursing homes owned by private investment groups.

The scope of the inquiries by Representatives John D. Dingell of Michigan, chairman of the Energy and Commerce Committee, and Barney Frank of Massachusetts, head of the Financial Services Committee, are still being determined, but will probably include hearings and proposed legislation, a committee spokeswoman said.

The investigations are the latest scrutiny of private equity investments in nursing homes.

Last week, Senators Max Baucus, Democrat of Montana and chairman of the Finance Committee, and Charles E. Grassley, Republican of Iowa and its ranking minority member, sent letters to five private investment firms seeking information on their ownership and management of nursing home chains. The senators also asked the agency responsible for many payments to nursing homes, the Centers for Medicare and Medicaid Services, about its oversight of such homes.

This month, officials in five states expressed concern about the Carlyle Group’s $6.3 billion acquisition of the nation’s largest nursing home chain, HCR Manor Care. State legislators in Florida, Illinois, Pennsylvania, Michigan and Washington have asked regulators to investigate the acquisition by Carlyle, a private equity giant, or withhold approval pending greater scrutiny.

“There are serious concerns that private equity firms are reducing the care at nursing homes by decreasing the number of employees,” Mr. Dingell said. “We’ve been made aware that nursing home residents are losing their ability to use lawsuits to fight poor care, and that people may be suffering.”

It should never get to the point where I lawsuit is needed; nursing care should come first even over the profit margin. Alas we know better.

Representatives of the Carlyle Group and other private equity firms said their companies intended to cooperate with all inquiries. Carlyle said it was committed to maintaining high standards at the 552 Manor Care facilities after the deal closes, which is expected late this year.
[…]
To counter such criticisms, Manor Care began sending letters to regulators and officials in the 32 states where its facilities are located, pledging to maintain staff levels and other quality standards. The company has also sent letters to residents and their families criticizing the article in The Times and the union’s efforts. The mailings have said that the Carlyle Group does not intend to overhaul Manor Care in ways that make it harder for regulators to trace ownership.

But documents filed with Maryland regulators indicate that Carlyle plans to reorganize Manor Care to make each nursing home a stand-alone company, and to separate ownership of the homes’ real estate and operations. Other private investment groups have used such structures to avoid liability and regulatory scrutiny.

Uh huh…here we go. Already these groups are trying to hide the very people who should be held accountable when poor care results in actual harm or even deaths of residents, all in the name of profits.

The Congressional inquiries and hearings may lead to significant shifts within the nursing home industry.

“When Congress has examined nursing homes in the past, it’s led to fundamental changes,” said David Zimmerman, a professor at the University of Wisconsin and president of the Long Term Care Institute, a nonprofit group. “The government pays for a great deal of nursing home care. If they demand transparency on ownership and liability, they’ll get it. Private equity groups have reasons to be concerned.”

Let’s hope so. Let’s get the profit motive out of the nursing home business and put the caring motive back. These places are bad enough, we don’t need any help from people who have no idea what it is we do…private equity groups should be banned from having anything to do with health care facilities.

…is worth so much. Do the elderly have poor sleep patterns?

As every sleep researcher knows, the surest way to hear complaints about sleep is to ask the elderly.

“Older people complain more about their sleep; they just do,” said Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington.

And for years, sleep scientists thought they knew what was going on: sleep starts to deteriorate in late middle age and steadily erodes from then on. It seemed so obvious that few thought to question the prevailing wisdom.

Now, though, new research is leading many to change their minds. To researchers’ great surprise, it turns out that sleep does not change much from age 60 on. And poor sleep, it turns out, is not because of aging itself, but mostly because of illnesses or the medications used to treat them.

“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”

Across the pond we see similar issues we face daily. Getting residents up at 5:30am is considered abuse.

A NURSE was reported to watchdogs after she ordered dementia patients out of their beds at 5.30am.

The Care Commission upheld a complaint that up to 18 elderly residents were taken out of their beds and left to sit in a lounge until breakfast.

Some residents had to wait more than two hours before they could be fed when the kitchen staff arrived for work at 8am.

Joyce Lynn, a district nurse, works part-time at Greenhills Care Home in Biggar, Lanarkshire, where the abuse allegedly took place.

And she works as a nurse attached to Lady Home Hospital in Douglas, also Lanarkshire.

Sounds familiar.

Watchdogs who examined the claims of early starts for patients were told that some of them were taken out of bed and left to doze in their wheelchairs in the residents’ lounge.

One source said: “Some of them just wanted to go back to bed but they were just left in the lounge to sleep there. Sometimes they didn’t even get a cup of tea until breakfast.

“Some were put in baths at that time in the morning. It was ridiculous.”

Lynn was a staff nurse on night shift and sources claim that she maintained there was not enough time for the day shift to get everyone up in time for breakfast.

The source said: “If we protested, we were told to just get on with it.”

The Care Commission gave the home 24 hours to stop disturbing patients at such an early hour.

They ruled: “The practice of disturbing residents at early hours of the morning will cease.

It happens here in the US often. But we don’t think of it as abuse.

Carlyle Group has put in writing that it will not cut back on resources and staffing with the Manor Care buyout.

The Carlyle Group, under siege for weeks by a labor union critical of its $6.3 billion purchase of Manor Care nursing homes, has taken the rare step of putting in writing its promise to provide adequate staffing and resources to the chain.

The District-based buyout giant said it has sent to state regulators across the nation a “patients first” pledge, vowing to provide quality services to patients and proper education and training to staffers who care for them. The private-equity firm also said it will make the investments necessary to “ensure Manor Care’s facilities continue to be . . . state of the art.”

The pledge comes in the wake of concerns over whether the private-equity firm might cut staffing and reduce patient care in pursuit of financial goals.

“We are confident, because we have been doing this for 20 years, that we can provide quality products and services to people that is completely compatible with providing a return to investors,” said Karen H. Bechtel, Carlyle managing director and head of its health care team.

Health-care experts differed on the value of Carlyle’s pledge.

David A. Goldstein, an associate professor of clinical medicine at the University of Southern California Keck School of Medicine, said he considered Carlyle’s pledge “relatively meaningless.” He added, “For-profit companies should not be in the business of health care. Their allegiance is not to patients. It’s to their stockholders.”

But Joseph C. d’Oronzio, associate professor of health policy at Columbia University’s Mailman School of Public Health, called the pledge “a positive and good gesture.” He added that “Carlyle won’t be able to run a nursing home and get Medicaid and insurance funding without toeing that line and answering to state regulators.”

We’ll see. Written words mean little when the excuses start coming in. Census numbers and levels of acuity will be used- just watch. And let’s keep an eye on the profit margins too.

Why it’s so important to maintain professional relationships with residents.

OLYMPIA — A 20-year-old woman has lost her nursing assistant’s license after being accused of accepting $145,000 in gifts — including jewelry, a car, a stock portfolio and a trip to Disneyland — from an elderly man before he died at an Olympia assisted-living facility in 2006.

Lila Guzman collected the gifts from Damiano Buffone from 2004 to 2006, starting when she was 18 and Buffone was a resident of Merrill Gardens on Lilly Road, according court records and a statement of administrative charges filed by the state Department of Health against Guzman this year.
[…]
According to the civil suit filed by Buffone’s daughter:

“Over a period of time from November, 2004 to May, 2006, defendant received approximately $145,000 from the decedent in the form of checks. Additionally, shares of stock managed by Merrill Lynch was transferred to the defendant.”

The suit alleges that before Buffone’s death June 6, 2006, Guzman “coerced” him into giving her stock and money while she worked at Merrill Gardens. Horn’s attorneys were able to freeze Guzman’s stock holdings, as well as at least one of her bank accounts, after Buffone’s death, the complaint states.

Now, Guzman is broke, unable to pay the money she has been ordered to give Horn as part of the judgment, Benjamin said.

“She has no money because all of her assets were frozen and taken away,” he said.

More Congressional fallout for the private equity buyouts of nursing homes.

Private equity firms have been rapidly buying up nursing homes in the last few years, sometimes using complex ownership structures to shield them from lawsuits. Now they have attracted attention in Washington.

Two members of the United States Senate on Thursday asked the federal agency that oversees nursing home inspections to account for what The New York Times described in September as an increase in health and safety violations at nursing homes bought by private investors. The lawmakers, Max Baucus of Montana of Chuck Grassley of Iowa, also sent letters to private equity firms, including the Carlyle Group and Warburg Pincus, seeking information about their nursing home investments.

Mr. Baucus, a Democrat, and Mr. Grassley, a Republican, are the chairman and ranking member, respectively, of the Senate Finance Committee. They have already squared off with some of the biggest players in the private equity industry. Earlier this year, they proposed a bill that would more than double the tax rate on publicly traded investment firms such as the Blackstone Group and the Fortress Investment Group. Such a measure would also likely apply to Kohlberg Kravis Roberts if it goes through with its plan to go public.

On Thursday, the two lawmakers turned their attention to private equity’s role in the nursing home industry. Most nursing home fees are paid by Medicaid and Medicare, two programs overseen by the Senate Finance Committee.

In a press release, Mr. Baucus and Mr. Grassley expressed concern about the findings in the report, by The Times’ Charles Duhigg, that after nursing homes were acquired by buyout firms, their residents were generally worse off than under the previous owners.

“Nursing homes aren’t just investment vehicles,” Mr. Baucus said in a statement. “They’re homes for some of America’s most vulnerable citizens.”

Let’s hope this attention from Congress scares off some of these unethical groups. Sometimes though, these investigations and hearings only serve to create more unscrupulous investing deals- the bad guys learn how to hide themselves even more. We will stay on top of this.